MEDICARE: AUBREY FAITH STEWART APCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APCC18719	CA
2	101Y00000X	Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1265258313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY FAITH STEWART APCC

Provider Business Mailing Address
First Line	:	2444 BARRY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2444 BARRY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3280
Country	:	US
Telephone Number	:	310-450-4050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	02/13/2025

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